Organ Retractor for Tissue Manipulation

Clinical Resources

Retraction or suspension is a fundamental requirement for all surgical procedures and is more challenging in minimally invasive procedures. Minimally invasive surgery, including laparoscopic and robotic procedures, lack techniques and tools for optimal tissue and organ retraction; visualization is often suboptimal and deployment of retractors commonly requires the use of an extra port and/or an assistant to hold and reposition the device.

Most commonly used retractors have been shown to increase complications and often necessitated the use of more challenging techniques for success:

  • The Nathanson liver retractor causes more liver dysfunction than V-LIST or the liver suspension technique and causes more postoperative pain than the liver suspension technique.1
  • Suture suspension of the gallbladder yielded significantly lower complication rates compared with instrument usage (3.3% vs 13.3% p<0.0001)2
    • Common intraoperative complications: gallbladder perforation, bile spillage and hemorrhage
    • Common postoperative complications: wound infection and hematoma, bile leakage, and residual choledocholithiasis

A trend toward more minimally invasive laparoscopic approaches has led to techniques of single-incision and natural orifice laparoscopic surgery. Increased focus on reducing the number of incisions (cost, pain, and aesthetics) also contributes to the need for new retraction solutions.

An ideal method for liver retraction during laparoscopic upper abdominal surgery would lift the liver out of the operative field in a nontraumatic manner, providing adequate space for visualization and operation for as long as required, and without the need for additional ports or assistance. Reducing the number of abdominal incisions will improve cosmesis and reduce risks for wound complications and postoperative pain.3 In summary, an ideal solution will:

  • Utilize existing trocars
  • Remain completely intracorporeal
  • Optimize visualization
  • Provide for hands-free retraction
  • Allow for complete and continuous adjustments without tool exchanges
  • Remove the need for an assistant

1 Randomized controlled trial comparing three methods of liver retraction in laparoscopic Roux-en-Y gastric bypass

Rajat Goel; Asim Shabbir; Chi-Ming Tai; Alvin Eng; Hung-Yen Lin; Su-Long Lee; Chih-Kun Huang

Surgical Endoscopy; 2013, Feb; 27(2): 679-684. DOI: 10.1007/s00464-012-2438-6. Epub 2012 Jul 7.

Traditional liver retractors require another wound for insertion are bulky, and may cause iatrogenic liver injury. This study aimed to evaluate differences between three methods of liver retraction during laparoscopic Roux-en-Y Gastric bypass (LRYGB) and to compare novel liver retraction techniques with the traditional mechanical liver retractor in a randomized controlled trial.

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2 Single-incision laparoscopic cholecystectomy: a systematic review

Stavros A. Antoniou; Rudolph Pointner; Frank A. Granderath

Surgical Endoscopy; 2011 Feb; 25(2):367-77. DOI: 10.1007/s00464-010-1217-5. Epub 2010 Jul 7.

A trend toward even more minimally invasive laparoscopic approaches has led to techniques of single-incision and natural orifice laparoscopic surgery. This article is a systematic review of the literature which examines the feasibility, safety, and results of single-incision laparoscopic cholecystectomy (SILC), and defines, if possible, the limitations of this technique.

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3 A Suture-Based Liver Retraction Method For Laparoscopic Bariatric Procedures: Results From A Large Case Series

Roger de la Torre; J.Stephen Scot; Emily Cole

Surgery for Obesity and Related Diseases (2015) 00-00
http://dx.doi.org/10.1016/j.soard.2015.01.021

In this large case series of patients with a high rate of morbid obesity, we have reported the tolerability and efficacy of a suture-based method for liver retraction. The rate of liver complications related to the retraction method was extremely low (0.4%), and these events were minor and resolved without sequelae.

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4 Three-Port Versus Standard Four-Port Laparoscopic Cholecystectomy: A Randomized Controlled Clinical Trial in a Community-Based Teaching Hospital in Eastern Nepal

Manoj Kumar, MS, DNB, MNAMS, MRCS (Edin), Chandra Shekhar Agrawal, MS, and Rakesh Kumar Gupta, MS

Journal of the Society of Laparoendoscopic Surgeons
Society of Laparoendoscopic Surgeons. 2007 Jul-Sep; 11(3): 358–362

The prevalence of laparoscopic cholecystectomies has increased in frequency leading to an increase in both surgeon experience and technical refinements, specifically the number of ports used and their size. The 3-port laparoscopic cholecystectomy has already been established as being safe. The design of this study sought to determine if there were any additional advantages compared with the conventional 4-port laparoscopic cholecystectomy.

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